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School Health Forms

PHYSICAL EXAMS AND HEALTH FORMS

Ilinois law requires physical examinations for students entering kindergarten and sixth grade and for new enrollees from outside the State of Illinois. A copy of the health examination report, signed by a physician and dated within the past 12 months, must be on record with the District.Record of immunizations against measles, mumps, rubella, diphtheria, tetanus, pertussis, poliomyelitis, and varicella must be present. All 6th grade students are required to have a completed hepatitis B series, and a Tdap booster. All 6th graders must show proof of one meningococcal conjugate vaccine (MCV) given on or after the 11th birthday. If the health/immunization records are not in compliance with the Illinois School Code and the report is not received prior to October 15 of the school year, the student will be excluded from school until the report is in compliance.The exam must be reported on the Illinois Certificate of Child Health Examination form, available in the right hand column, which was updated in February 2013. Exams reported on IESA sports physical forms are not acceptable for this purpose. Parents: Please complete the top of page one and page two, and sign page two of the form. Please keep a copy of the completed form for your records.

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Illinois law requires physical examinations for students entering kindergarten and sixth grade and for new enrollees from outside the State of Illinois. A copy of the health examination report, signed by a physician and dated within the past 12 months, must be on record with the District.

Record of immunizations against measles, mumps, rubella, diphtheria, tetanus, pertussis, poliomyelitis, and varicella must be present. All 6th grade students are required to have a completed hepatitis B series, and a Tdap booster. New for Fall 2015, all 6th graders must show proof of one meningococcal conjugate vaccine (MCV) given on or after the 11th birthday. If the health/immunization records are not in compliance with the Illinois School Code and the report is not received prior to October 15 of the school year, the student will be excluded from school until the report is in compliance.

The exam must be reported on the Illinois Certificate of Child Health Examination form, available in the right hand column, which was updated in February 2013. Exams reported on IESA sports physical forms are not acceptable for this purpose. Parents: Please complete the top of page one and page two, and sign page two of the form. Please keep a copy of the completed form for your records.

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